NPI | 1811450885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65048) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 023457) |
Enumeration Date | 2019-04-08 |
Last Update Date | 2025-06-02 |